Journal of Obstetrics and Gynaecology (2000) Vol. 20, No. 2, 183± 184

GYNAECOLOGY SHORT COMMUNICATION

Patient satisfaction with the care provided at agynaecology oncology clinic

A. VASHISHT, C. L. DOMONEY, K. HANDSCOMB, J. R. SMITH and J. E. BRIDGESImperial College of Science and Medicine, Chelsea and Westminster Hospital, London, UK

IntroductionThere is a certain amount of uncertainty as to the

optimal duration and frequency of follow up of patients

with gynaecological cancer. This has been highlighted

by studies revealing inconsistencies in follow-up regimes

(Van Voorhis, 1970; Barnhill et al., 1992; Kerr-Wilson

and McCrum, 1995). Attempts have been made to

identify objectives in the management of the oncology

patient including assessing results of therapy, early

detection of recurrence and treatment for the side

effects of therapy (Planner, 1995). However, these do

not speci® cally address the issue of patient satisfaction

with respect to their medical consultation as well as

their treatment, involvement in decision making, or

desire for more information.

Patien t dissatisfaction may occur if they feel

consultations are too short or infrequent, or if they

feel that too little information is given, or badly

presented. Increasing attempts are made by clinicians

to involve patients in their own management. This has

occurred partly from the patients’ own desires for more

information, evident across all patient age groups but

in particular amongst younger patients (Cassileth et

al., 1980). M ethods of improving patient information

have been explored, with some consultations being

audio-taped or patients receiving letters detailing their

consultation (Tattersall et al., 1994) Seventy-nine

percent of doctors involved in the care of oncology

patients thought that some form of written communica-

tion to the patient outlining the consultation would be

useful to the patient (Damian and Tattersall, 1991).

Patients differ in how much they care to seek further

information regarding their illness, and how involved

they wish to become in their subsequent management.

Indeed, patients who are given inform ation ® les

detailing descriptions of their disease, staging, treat-

ments, and sources of further information, may not

differ signi® cantly when later questioned on their cancer

knowledge, or satisfaction with information received

(Berner et al., 1997).

Physicians may feel threatened that decision making

will be taken away from them by patients’ desires to

have maximum information. This is not necessarily the

case. Cassileth (1980) found that 83% of patients

requested all information, but only 63% wanted to

participate in management decisions. Many patients

may actively seek more information, but the majority

prefer the physician to assume the role of primary

decision maker (Sutherland et al., 1989).

At the Chelsea and Westm inster hospital, our

oncology service has been established in accordance

with standards from the West London Cancer Group.

Eighteen months ago, a M acmillan Gynae-oncology

nurse was introduced to facilitate a multiprofessional

team approach to the service. We have recently

implemented protocols regarding treatment and follow

up of patients with gynaecological m alignancy,

dependent on tumour origin, stage and grade. Our

study was designed to gauge patient satisfaction with

the current service, in order to evaluate and review the

care provided.

MethodsA simple anonymous questionnaire was given to 52

consecutive patients at the gynaecology oncology clinic

at the Chelsea and Westminster hospital between July

and October 1998. Information was obtained as to

how long they had attended the clinic (0± 6 months,

6± 12 months, 1± 3 years, 3± 5 years, or more than 5

years). Questions were then asked as to who they would

most like their consultation with (hospital doctor,

M acm illan nurse, GP, or hospital doctor and

Macmillan nurse), whether the frequency and dura-

tion of their consultation was `too short’ , `too long’ or

`about right’ , whether they would like a copy of the

letter the hospital sends to their GP, and whether they

would like further information regarding their disease.

ResultsForty-eight questionnaires were completed. All but one

patient thought the quantity of information given at

the consultation was `about right’ , and that the length

of the consultation was `about right’ . Five patients

thought that the length of time between consultation

was too long and one too short. Forty-four patients

felt all their questions had been answered, the other

four thought this was not the case because of time

constraints, feeling intimidated by the doctor and

simply that the `doctors do not know the answers’ .

Forty-six patients found the clinic reassuring, with only

two ® nding it anxiety provoking. All patients requested

that they either see just a hospital doctor (58%) or a

hospital doctor and M acmillan nurse (42%). No

patients requested follow-up with their GP. A Somers’

D statistical analysis was performed to evaluate whether

there was a correlation between the length of attend-

ance at the clinic and desire to see a Macmillan nurse.

Correspondence to: Mr J. R. Smith, The Lister Hospital, Chelsea Bridge Road, London SW1W 8RH, UK.

ISSN 0144± 3615 print/ISSN 1364± 6893 online/00/020183± 02 � Institute of Obstetrics and Gynaecology Trust, 2000

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There was a negative correlation ± 17% (95% C.I:

± 38± 4%). Furthermore we looked to see if those

patients who wished to see a M acmillan nurse would

also be more likely to want further information

regarding their disease. A positive correlation of 48%

(95% C.I.: 22 ± 74%) was found.

Eighty-three percent of patients replied that they

would like to have a copy of the letter the hospital

sends to their GP. There was no particular correlation

when matched to duration of attendance.

DiscussionOn the whole, most of our patients were satis® ed with

our clinic, both in terms of information given and

duration of and between appointments. We found that

many patients requested the input of a Macmillan nurse

in their management, although those who had attended

for a longer period were more likely to request the

consultation with just their hospital doctor. Patients

attending the clinic for longer than 18 months may not

have appreciated the role of the Macmillan nurse as

they would have not had access to her in the early

stages of their disease. This ® nding may also be

explained by the fact that those patients who are

relatively recently diagnosed are possibly more likely

to be faced with problems coming to terms with their

diagnosis. They may value the coordination of different

facets of their care by a Macmillan nurse. Certainly,

there was a correlation between those patients who

wished to see a Macmillan nurse and the desire for

more information.

Interestingly, no patients requested follow-up with

their GP. This contrasts with a recent study (Howells

et al., 1999) where more than a quarter of patients

requested hospital discharge and follow-up by their

GP. In this latter study no patients were receiving

further treatment, although this cannot solely account

for the discrepant ® ndings since the vast majority of

patients in our study were similarly not receiving treat-

ment.

We found no signi® cant relationship between dura-

tion of attendance and desire for more information or

request for a letter from the hospital. This reinforces

our opinion that although there maybe an increasing

trend for patients to request more information, it is

difficult to predict which patients these are. This makes

the implementation of rigid protocols regarding what

information to give inappropriate. We believe that

management should be patient-speci ® c , and that

regular auditing of different aspects of patient care

can optimise the service provided.

The m anagem ent of gynaeco logica l oncology

patients poses many potential difficulties. For clini-

cians, there is an objective to detect recurrence early

and to institute the appropriate treatment. For patients,

issues such as informed consent, involvement in treat-

ment decisions and wider access to different health-

care professionals, have becom e paramount.

Increasingly, the focus of treatment has shifted from

being disease- to patient-centred. This has meant that

the yardstick by which an oncology service is judged,

involves not only morbidity and mortality rates, but

also encompasses the concept of patient satisfaction.

AcknowledgementDr R. Newson for his assistance with statistical analysis.

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184 A. Vashisht et al.

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